Florida Senate - 2016                          SENATOR AMENDMENT
       Bill No. HB 85
       
       
       
       
       
       
                                Ì7255900Î725590                         
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
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                Floor: 1/RE/2R         .                                
             03/08/2016 07:02 PM       .                                
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       Senator Gaetz moved the following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Section 381.4019, Florida Statutes, is created
    6  to read:
    7         381.4019 Dental care access accounts.—Subject to the
    8  availability of funds, the Legislature establishes a joint local
    9  and state dental care access account initiative and authorizes
   10  the creation of dental care access accounts to promote economic
   11  development by supporting qualified dentists who practice in
   12  dental health professional shortage areas or medically
   13  underserved areas or who treat a medically underserved
   14  population. The Legislature recognizes that maintaining good
   15  oral health is integral to overall health status and that the
   16  good health of residents of this state is an important
   17  contributing factor in economic development. Better health,
   18  including better oral health, enables workers to be more
   19  productive, reduces the burden of health care costs, and enables
   20  children to improve in cognitive development.
   21         (1) As used in this section, the term:
   22         (a) “Dental health professional shortage area” means a
   23  geographic area so designated by the Health Resources and
   24  Services Administration of the United States Department of
   25  Health and Human Services.
   26         (b) “Department” means the Department of Health.
   27         (c) “Medically underserved area” means a geographic area so
   28  designated by the Health Resources and Services Administration
   29  of the United States Department of Health and Human Services.
   30         (d) “Public health program” means a county health
   31  department, the Children’s Medical Services Network, a federally
   32  qualified community health center, a federally funded migrant
   33  health center, or other publicly funded or nonprofit health care
   34  program as designated by the department.
   35         (2The department shall develop and implement a dental
   36  care access account initiative to benefit dentists licensed to
   37  practice in this state who demonstrate, as required by the
   38  department by rule:
   39         (a)Active employment by a public health program located in
   40  a dental health professional shortage area or a medically
   41  underserved area; or
   42         (b)A commitment to opening a private practice in a dental
   43  health professional shortage area or a medically underserved
   44  area, as demonstrated by the dentist residing in the designated
   45  area, maintaining an active Medicaid provider agreement,
   46  enrolling in one or more Medicaid managed care plans, expending
   47  sufficient capital to make substantial progress in opening a
   48  dental practice that is capable of serving at least 1,200
   49  patients, and obtaining financial support from the local
   50  community in which the dentist is practicing or intending to
   51  open a practice.
   52         (3) The department shall establish dental care access
   53  accounts as individual benefit accounts for each dentist who
   54  satisfies the requirements of subsection (2) and is selected by
   55  the department for participation. The department shall implement
   56  an electronic benefit transfer system that enables each dentist
   57  to spend funds from his or her account for the purposes
   58  described in subsection (4).
   59         (4Funds contributed from state and local sources to a
   60  dental care access account may be used for one or more of the
   61  following purposes:
   62         (a) Repayment of dental school student loans.
   63         (b) Investment in property, facilities, or equipment
   64  necessary to establish and operate a dental office consisting of
   65  no fewer than two operatories.
   66         (c) Payment of transitional expenses related to the
   67  relocation or opening of a dental practice which are
   68  specifically approved by the department.
   69         (5Subject to legislative appropriation, the department
   70  shall distribute state funds as an award to each dental care
   71  access account. An individual award must be in an amount not
   72  more than $100,000 and not less than $10,000, except that a
   73  state award may not exceed 3 times the amount contributed to an
   74  account in the same year from local sources. If a dentist
   75  qualifies for a dental care access account under paragraph
   76  (2)(a), the dentist’s salary and associated employer
   77  expenditures constitute a local match and qualify the account
   78  for a state award if the salary and associated expenditures do
   79  not come from state funds. State funds may not be included in a
   80  determination of the amount contributed to an account from local
   81  sources.
   82         (6) The department may accept contributions of funds from a
   83  local source for deposit in the account of a dentist designated
   84  by the donor.
   85         (7) The department shall close an account no later than 5
   86  years after the first deposit of state or local funds into that
   87  account or immediately upon the occurrence of any of the
   88  following:
   89         (a) Termination of the dentist’s employment with a public
   90  health program, unless, within 30 days after such termination,
   91  the dentist opens a private practice in a dental health
   92  professional shortage area or medically underserved area.
   93         (b) Termination of the dentist’s practice in a designated
   94  dental health professional shortage area or medically
   95  underserved area.
   96         (c) Termination of the dentist’s participation in the
   97  Florida Medicaid program.
   98         (d) Participation by the dentist in any fraudulent
   99  activity.
  100         (8) Any state funds remaining in a closed account may be
  101  awarded and transferred to another account concurrent with the
  102  distribution of funds under the next legislative appropriation
  103  for the initiative. The department shall return to the donor on
  104  a pro rata basis unspent funds from local sources which remain
  105  in a closed account.
  106         (9) If the department determines that a dentist has
  107  withdrawn account funds after the occurrence of an event
  108  specified in subsection (7), has used funds for purposes not
  109  authorized in subsection (4), or has not remained eligible for a
  110  dental care access account for a minimum of 2 years, the dentist
  111  shall repay the funds to his or her account. The department may
  112  recover the withdrawn funds through disciplinary enforcement
  113  actions and other methods authorized by law.
  114         (10) The department shall establish by rule:
  115         (a) Application procedures for dentists who wish to apply
  116  for a dental care access account. An applicant may demonstrate
  117  that he or she has expended sufficient capital to make
  118  substantial progress in opening a dental practice that is
  119  capable of serving at least 1,200 patients by documenting
  120  contracts for the purchase or lease of a practice location and
  121  providing executed obligations for the purchase or other
  122  acquisition of at least 30 percent of the value of equipment or
  123  supplies necessary to operate a dental practice. The department
  124  may limit the number of applicants selected and shall give
  125  priority to those applicants practicing in the areas receiving
  126  higher rankings pursuant to subsection (11). The department may
  127  establish additional criteria for selection which recognize an
  128  applicant’s active engagement with and commitment to the
  129  community providing a local match.
  130         (b)A process to verify that funds withdrawn from a dental
  131  care access account have been used solely for the purposes
  132  described in subsection (4).
  133         (11) The Department of Economic Opportunity shall rank the
  134  dental health professional shortage areas and medically
  135  underserved areas of the state based on the extent to which
  136  limited access to dental care is impeding the areas’ economic
  137  development, with a higher ranking indicating a greater
  138  impediment to development.
  139         (12) The department shall develop a marketing plan for the
  140  dental care access account initiative in cooperation with the
  141  University of Florida College of Dentistry, the Nova
  142  Southeastern University College of Dental Medicine, the Lake
  143  Erie College of Osteopathic Medicine School of Dental Medicine,
  144  and the Florida Dental Association.
  145         (13)(a) By January 1 of each year, beginning in 2018, the
  146  department shall issue a report to the Governor, the President
  147  of the Senate, and the Speaker of the House of Representatives
  148  which must include:
  149         1. The number of patients served by dentists receiving
  150  funding under this section.
  151         2. The number of Medicaid recipients served by dentists
  152  receiving funding under this section.
  153         3. The average number of hours worked and patients served
  154  in a week by dentists receiving funding under this section.
  155         4. The number of dentists in each dental health
  156  professional shortage area or medically underserved area
  157  receiving funding under this section.
  158         5. The amount and source of local matching funds received
  159  by the department.
  160         6. The amount of state funds awarded to dentists under this
  161  section.
  162         7. A complete accounting of the use of funds by categories
  163  identified by the department, including, but not limited to,
  164  loans, supplies, equipment, rental property payments, real
  165  property purchases, and salary and wages.
  166         (b) The department shall adopt rules to require dentists to
  167  report information to the department which is necessary for the
  168  department to fulfill its reporting requirement under this
  169  subsection.
  170         Section 2. Subsection (3) of section 395.002, Florida
  171  Statutes, is amended to read:
  172         395.002 Definitions.—As used in this chapter:
  173         (3) “Ambulatory surgical center” or “mobile surgical
  174  facility” means a facility the primary purpose of which is to
  175  provide elective surgical care, in which the patient is admitted
  176  to and discharged from such facility within 24 hours the same
  177  working day and is not permitted to stay overnight, and which is
  178  not part of a hospital. However, a facility existing for the
  179  primary purpose of performing terminations of pregnancy, an
  180  office maintained by a physician for the practice of medicine,
  181  or an office maintained for the practice of dentistry shall not
  182  be construed to be an ambulatory surgical center, provided that
  183  any facility or office which is certified or seeks certification
  184  as a Medicare ambulatory surgical center shall be licensed as an
  185  ambulatory surgical center pursuant to s. 395.003. Any structure
  186  or vehicle in which a physician maintains an office and
  187  practices surgery, and which can appear to the public to be a
  188  mobile office because the structure or vehicle operates at more
  189  than one address, shall be construed to be a mobile surgical
  190  facility.
  191         Section 3. Present subsections (6) through (10) of section
  192  395.003, Florida Statutes, are redesignated as subsections (7)
  193  through (11), respectively, a new subsection (6) is added to
  194  that section, and present subsections (9) and (10) of that
  195  section are amended, to read:
  196         395.003 Licensure; denial, suspension, and revocation.—
  197         (6) An ambulatory surgical center, as a condition of
  198  initial licensure and license renewal, must provide services to
  199  Medicare patients, Medicaid patients, and patients who qualify
  200  for charity care in an amount equal to or greater than the
  201  applicable district average among licensed providers of similar
  202  services. Ambulatory surgical centers shall report the same
  203  financial, patient, postoperative surgical infection, and other
  204  data pursuant to s. 408.061 as reported by hospitals to the
  205  Agency for Health Care Administration or otherwise published by
  206  the agency. For the purposes of this subsection, “charity care”
  207  means uncompensated care delivered to uninsured patients with
  208  incomes at or below 200 percent of the federal poverty level
  209  when such services are preauthorized by the licensee and not
  210  subject to collection procedures. An ambulatory surgical center
  211  that keeps patients later than midnight on the day of the
  212  procedure must comply with the same building codes and
  213  lifesafety codes as a hospital.
  214         (10)(9) A hospital licensed as of June 1, 2004, shall be
  215  exempt from subsection (9) subsection (8) as long as the
  216  hospital maintains the same ownership, facility street address,
  217  and range of services that were in existence on June 1, 2004.
  218  Any transfer of beds, or other agreements that result in the
  219  establishment of a hospital or hospital services within the
  220  intent of this section, shall be subject to subsection (9)
  221  subsection (8). Unless the hospital is otherwise exempt under
  222  subsection (9) subsection (8), the agency shall deny or revoke
  223  the license of a hospital that violates any of the criteria set
  224  forth in that subsection.
  225         (11)(10) The agency may adopt rules implementing the
  226  licensure requirements set forth in subsection (9) subsection
  227  (8). Within 14 days after rendering its decision on a license
  228  application or revocation, the agency shall publish its proposed
  229  decision in the Florida Administrative Register. Within 21 days
  230  after publication of the agency’s decision, any authorized
  231  person may file a request for an administrative hearing. In
  232  administrative proceedings challenging the approval, denial, or
  233  revocation of a license pursuant to subsection (9) subsection
  234  (8), the hearing must be based on the facts and law existing at
  235  the time of the agency’s proposed agency action. Existing
  236  hospitals may initiate or intervene in an administrative hearing
  237  to approve, deny, or revoke licensure under subsection (9)
  238  subsection (8) based upon a showing that an established program
  239  will be substantially affected by the issuance or renewal of a
  240  license to a hospital within the same district or service area.
  241         Section 4. Section 624.27, Florida Statutes, is created to
  242  read:
  243         624.27 Application of code as to direct primary care
  244  agreements.—
  245         (1) As used in this section, the term:
  246         (a) “Direct primary care agreement” means a contract
  247  between a primary care provider and a patient, the patient’s
  248  legal representative, or an employer which meets the
  249  requirements specified under subsection (4) and does not
  250  indemnify for services provided by a third party.
  251         (b) “Primary care provider” means a health care
  252  practitioner licensed under chapter 458, chapter 459, chapter
  253  460, or chapter 464, or a primary care group practice that
  254  provides medical services to patients which are commonly
  255  provided without referral from another health care provider.
  256         (c) “Primary care service” means the screening, assessment,
  257  diagnosis, and treatment of a patient for the purpose of
  258  promoting health or detecting and managing disease or injury
  259  within the competency and training of the primary care provider.
  260         (2) A direct primary care agreement does not constitute
  261  insurance and is not subject to chapter 636 or any other chapter
  262  of the Florida Insurance Code. The act of entering into a direct
  263  primary care agreement does not constitute the business of
  264  insurance and is not subject to chapter 636 or any other chapter
  265  of the Florida Insurance Code.
  266         (3) A primary care provider or an agent of a primary care
  267  provider is not required to obtain a certificate of authority or
  268  license under chapter 636 or any other chapter of the Florida
  269  Insurance Code to market, sell, or offer to sell a direct
  270  primary care agreement.
  271         (4) For purposes of this section, a direct primary care
  272  agreement must:
  273         (a) Be in writing.
  274         (b) Be signed by the primary care provider or an agent of
  275  the primary care provider and the patient, the patient’s legal
  276  representative, or an employer.
  277         (c) Allow a party to terminate the agreement by giving the
  278  other party at least 30 days’ advance written notice. The
  279  agreement may provide for immediate termination due to a
  280  violation of the physician-patient relationship or a breach of
  281  the terms of the agreement.
  282         (d) Describe the scope of primary care services that are
  283  covered by the monthly fee.
  284         (e) Specify the monthly fee and any fees for primary care
  285  services not covered by the monthly fee.
  286         (f) Specify the duration of the agreement and any automatic
  287  renewal provisions.
  288         (g) Offer a refund to the patient of monthly fees paid in
  289  advance if the primary care provider ceases to offer primary
  290  care services for any reason.
  291         (h) Contain in contrasting color and in not less than 12
  292  point type the following statements on the same page as the
  293  applicant’s signature:
  294         1. The agreement is not health insurance and the primary
  295  care provider will not file any claims against the patient’s
  296  health insurance policy or plan for reimbursement of any primary
  297  care services covered by the agreement.
  298         2. The agreement does not qualify as minimum essential
  299  coverage to satisfy the individual shared responsibility
  300  provision of the Patient Protection and Affordable Care Act, 26
  301  U.S.C. s. 5000A.
  302         Section 5. The sections created and amendments made by this
  303  act to ss. 409.967, 627.42392, 641.31, and 641.394, Florida
  304  Statutes, may be known as the “Right Medicine Right Time Act.”
  305         Section 6. Effective January 1, 2017, paragraph (c) of
  306  subsection (2) of section 409.967, Florida Statutes, is amended
  307  to read:
  308         409.967 Managed care plan accountability.—
  309         (2) The agency shall establish such contract requirements
  310  as are necessary for the operation of the statewide managed care
  311  program. In addition to any other provisions the agency may deem
  312  necessary, the contract must require:
  313         (c) Access.—
  314         1. The agency shall establish specific standards for the
  315  number, type, and regional distribution of providers in managed
  316  care plan networks to ensure access to care for both adults and
  317  children. Each plan must maintain a regionwide network of
  318  providers in sufficient numbers to meet the access standards for
  319  specific medical services for all recipients enrolled in the
  320  plan. The exclusive use of mail-order pharmacies may not be
  321  sufficient to meet network access standards. Consistent with the
  322  standards established by the agency, provider networks may
  323  include providers located outside the region. A plan may
  324  contract with a new hospital facility before the date the
  325  hospital becomes operational if the hospital has commenced
  326  construction, will be licensed and operational by January 1,
  327  2013, and a final order has issued in any civil or
  328  administrative challenge. Each plan shall establish and maintain
  329  an accurate and complete electronic database of contracted
  330  providers, including information about licensure or
  331  registration, locations and hours of operation, specialty
  332  credentials and other certifications, specific performance
  333  indicators, and such other information as the agency deems
  334  necessary. The database must be available online to both the
  335  agency and the public and have the capability to compare the
  336  availability of providers to network adequacy standards and to
  337  accept and display feedback from each provider’s patients. Each
  338  plan shall submit quarterly reports to the agency identifying
  339  the number of enrollees assigned to each primary care provider.
  340         2.a. Each managed care plan must publish any prescribed
  341  drug formulary or preferred drug list on the plan’s website in a
  342  manner that is accessible to and searchable by enrollees and
  343  providers. The plan must update the list within 24 hours after
  344  making a change. Each plan must ensure that the prior
  345  authorization process for prescribed drugs is readily accessible
  346  to health care providers, including posting appropriate contact
  347  information on its website and providing timely responses to
  348  providers. For Medicaid recipients diagnosed with hemophilia who
  349  have been prescribed anti-hemophilic-factor replacement
  350  products, the agency shall provide for those products and
  351  hemophilia overlay services through the agency’s hemophilia
  352  disease management program.
  353         b. If a managed care plan restricts the use of prescribed
  354  drugs through a fail-first protocol, it must establish a clear
  355  and convenient process that a prescribing physician may use to
  356  request an override of the restriction from the managed care
  357  plan. The managed care plan shall grant an override of the
  358  protocol within 24 hours if:
  359         (I) Based on sound clinical evidence, the prescribing
  360  provider concludes that the preferred treatment required under
  361  the fail-first protocol has been ineffective in the treatment of
  362  the enrollee’s disease or medical condition; or
  363         (II) Based on sound clinical evidence or medical and
  364  scientific evidence, the prescribing provider believes that the
  365  preferred treatment required under the fail-first protocol:
  366         (A) Is likely to be ineffective given the known relevant
  367  physical or mental characteristics and medical history of the
  368  enrollee and the known characteristics of the drug regimen; or
  369         (B) Will cause or is likely to cause an adverse reaction or
  370  other physical harm to the enrollee.
  371  
  372  If the prescribing provider follows the fail-first protocol
  373  recommended by the managed care plan for an enrollee, the
  374  duration of treatment under the fail-first protocol may not
  375  exceed a period deemed appropriate by the prescribing provider.
  376  Following such period, if the prescribing provider deems the
  377  treatment provided under the protocol clinically ineffective,
  378  the enrollee is entitled to receive the course of therapy that
  379  the prescribing provider recommends, and the provider is not
  380  required to seek approval of an override of the fail-first
  381  protocol. As used in this subparagraph, the term “fail-first
  382  protocol” means a prescription practice that begins medication
  383  for a medical condition with the most cost-effective drug
  384  therapy and progresses to other more costly or risky therapies
  385  only if necessary.
  386         3. Managed care plans, and their fiscal agents or
  387  intermediaries, must accept prior authorization requests for any
  388  service electronically.
  389         4. Managed care plans serving children in the care and
  390  custody of the Department of Children and Families shall must
  391  maintain complete medical, dental, and behavioral health
  392  encounter information and participate in making such information
  393  available to the department or the applicable contracted
  394  community-based care lead agency for use in providing
  395  comprehensive and coordinated case management. The agency and
  396  the department shall establish an interagency agreement to
  397  provide guidance for the format, confidentiality, recipient,
  398  scope, and method of information to be made available and the
  399  deadlines for submission of the data. The scope of information
  400  available to the department are shall be the data that managed
  401  care plans are required to submit to the agency. The agency
  402  shall determine the plan’s compliance with standards for access
  403  to medical, dental, and behavioral health services; the use of
  404  medications; and followup on all medically necessary services
  405  recommended as a result of early and periodic screening,
  406  diagnosis, and treatment.
  407         Section 7. Effective January 1, 2017, section 627.42392,
  408  Florida Statutes, is created to read:
  409         627.42392Fail-first protocols.—If an insurer restricts the
  410  use of prescribed drugs through a fail-first protocol, it must
  411  establish a clear and convenient process that a prescribing
  412  physician may use to request an override of the restriction from
  413  the insurer. The insurer shall grant an override of the protocol
  414  within 24 hours if:
  415         (1) Based on sound clinical evidence, the prescribing
  416  provider concludes that the preferred treatment required under
  417  the fail-first protocol has been ineffective in the treatment of
  418  the insured’s disease or medical condition; or
  419         (2) Based on sound clinical evidence or medical and
  420  scientific evidence, the prescribing provider believes that the
  421  preferred treatment required under the fail-first protocol:
  422         (a) Is likely to be ineffective given the known relevant
  423  physical or mental characteristics and medical history of the
  424  insured and the known characteristics of the drug regimen; or
  425         (b) Will cause or is likely to cause an adverse reaction or
  426  other physical harm to the insured.
  427  
  428  If the prescribing provider follows the fail-first protocol
  429  recommended by the insurer for an insured, the duration of
  430  treatment under the fail-first protocol may not exceed a period
  431  deemed appropriate by the prescribing provider. Following such
  432  period, if the prescribing provider deems the treatment provided
  433  under the protocol clinically ineffective, the insured is
  434  entitled to receive the course of therapy that the prescribing
  435  provider recommends, and the provider is not required to seek
  436  approval of an override of the fail-first protocol. As used in
  437  this section, the term “fail-first protocol” means a
  438  prescription practice that begins medication for a medical
  439  condition with the most cost-effective drug therapy and
  440  progresses to other more costly or risky therapies only if
  441  necessary.
  442         Section 8. Effective January 1, 2017, subsection (44) is
  443  added to section 641.31, Florida Statutes, to read:
  444         641.31 Health maintenance contracts.—
  445         (44) A health maintenance organization may not require a
  446  health care provider, by contract with another health care
  447  provider, a patient, or another individual or entity, to use a
  448  clinical decision support system or a laboratory benefits
  449  management program before the provider may order clinical
  450  laboratory services or in an attempt to direct or limit the
  451  provider’s medical decisionmaking relating to the use of such
  452  services. This subsection may not be construed to prohibit any
  453  prior authorization requirements that the health maintenance
  454  organization may have regarding the provision of clinical
  455  laboratory services. As used in this subsection, the term:
  456         (a) “Clinical decision support system” means software
  457  designed to direct or assist clinical decisionmaking by matching
  458  the characteristics of an individual patient to a computerized
  459  clinical knowledge base and providing patient-specific
  460  assessments or recommendations based on the match.
  461         (b) “Clinical laboratory services” means the examination of
  462  fluids or other materials taken from the human body, which
  463  examination is ordered by a health care provider for use in the
  464  diagnosis, prevention, or treatment of a disease or in the
  465  identification or assessment of a medical or physical condition.
  466         (c) “Laboratory benefits management program” means a health
  467  maintenance organization protocol that dictates or limits health
  468  care provider decisionmaking relating to the use of clinical
  469  laboratory services.
  470         Section 9. Effective January 1, 2017, section 641.394,
  471  Florida Statutes, is created to read:
  472         641.394 Fail-first protocols.—If a health maintenance
  473  organization restricts the use of prescribed drugs through a
  474  fail-first protocol, it must establish a clear and convenient
  475  process that a prescribing physician may use to request an
  476  override of the restriction from the health maintenance
  477  organization. The health maintenance organization shall grant an
  478  override of the protocol within 24 hours if:
  479         (1) Based on sound clinical evidence, the prescribing
  480  provider concludes that the preferred treatment required under
  481  the fail-first protocol has been ineffective in the treatment of
  482  the subscriber’s disease or medical condition; or
  483         (2) Based on sound clinical evidence or medical and
  484  scientific evidence, the prescribing provider believes that the
  485  preferred treatment required under the fail-first protocol:
  486         (a) Is likely to be ineffective given the known relevant
  487  physical or mental characteristics and medical history of the
  488  subscriber and the known characteristics of the drug regimen; or
  489         (b) Will cause or is likely to cause an adverse reaction or
  490  other physical harm to the subscriber.
  491  
  492  If the prescribing provider follows the fail-first protocol
  493  recommended by the health maintenance organization for a
  494  subscriber, the duration of treatment under the fail-first
  495  protocol may not exceed a period deemed appropriate by the
  496  prescribing provider. Following such period, if the prescribing
  497  provider deems the treatment provided under the protocol
  498  clinically ineffective, the subscriber is entitled to receive
  499  the course of therapy that the prescribing provider recommends,
  500  and the provider is not required to seek approval of an override
  501  of the fail-first protocol. As used in this section, the term
  502  “fail-first protocol” means a prescription practice that begins
  503  medication for a medical condition with the most cost-effective
  504  drug therapy and progresses to other more costly or risky
  505  therapies only if necessary.
  506         Section 10. Paragraphs (a) and (d) of subsection (3) and
  507  subsections (4) and (5) of section 766.1115, Florida Statutes,
  508  are amended to read:
  509         766.1115 Health care providers; creation of agency
  510  relationship with governmental contractors.—
  511         (3) DEFINITIONS.—As used in this section, the term:
  512         (a) “Contract” means an agreement executed in compliance
  513  with this section between a health care provider and a
  514  governmental contractor for volunteer, uncompensated services
  515  which allows the health care provider to deliver health care
  516  services to low-income recipients as an agent of the
  517  governmental contractor. The contract must be for volunteer,
  518  uncompensated services, except as provided in paragraph (4)(g).
  519  For services to qualify as volunteer, uncompensated services
  520  under this section, the health care provider, or any employee or
  521  agent of the health care provider, must receive no compensation
  522  from the governmental contractor for any services provided under
  523  the contract and must not bill or accept compensation from the
  524  recipient, or a public or private third-party payor, for the
  525  specific services provided to the low-income recipients covered
  526  by the contract, except as provided in paragraph (4)(g). A free
  527  clinic as described in subparagraph (d)14. may receive a
  528  legislative appropriation, a grant through a legislative
  529  appropriation, or a grant from a governmental entity or
  530  nonprofit corporation to support the delivery of contracted
  531  services by volunteer health care providers, including the
  532  employment of health care providers to supplement, coordinate,
  533  or support the delivery of such services. The appropriation or
  534  grant for the free clinic does not constitute compensation under
  535  this paragraph from the governmental contractor for services
  536  provided under the contract, nor does receipt or use of the
  537  appropriation or grant constitute the acceptance of compensation
  538  under this paragraph for the specific services provided to the
  539  low-income recipients covered by the contract.
  540         (d) “Health care provider” or “provider” means:
  541         1. A birth center licensed under chapter 383.
  542         2. An ambulatory surgical center licensed under chapter
  543  395.
  544         3. A hospital licensed under chapter 395.
  545         4. A physician or physician assistant licensed under
  546  chapter 458.
  547         5. An osteopathic physician or osteopathic physician
  548  assistant licensed under chapter 459.
  549         6. A chiropractic physician licensed under chapter 460.
  550         7. A podiatric physician licensed under chapter 461.
  551         8. A registered nurse, nurse midwife, licensed practical
  552  nurse, or advanced registered nurse practitioner licensed or
  553  registered under part I of chapter 464 or any facility which
  554  employs nurses licensed or registered under part I of chapter
  555  464 to supply all or part of the care delivered under this
  556  section.
  557         9. A midwife licensed under chapter 467.
  558         10. A health maintenance organization certificated under
  559  part I of chapter 641.
  560         11. A health care professional association and its
  561  employees or a corporate medical group and its employees.
  562         12. Any other medical facility the primary purpose of which
  563  is to deliver human medical diagnostic services or which
  564  delivers nonsurgical human medical treatment, and which includes
  565  an office maintained by a provider.
  566         13. A dentist or dental hygienist licensed under chapter
  567  466.
  568         14. A free clinic that delivers only medical diagnostic
  569  services or nonsurgical medical treatment free of charge to all
  570  low-income recipients.
  571         15. A pharmacy or pharmacist licensed under chapter 465.
  572         16.15. Any other health care professional, practitioner,
  573  provider, or facility under contract with a governmental
  574  contractor, including a student enrolled in an accredited
  575  program that prepares the student for licensure as any one of
  576  the professionals listed in subparagraphs 4.-9.
  577  
  578  The term includes any nonprofit corporation qualified as exempt
  579  from federal income taxation under s. 501(a) of the Internal
  580  Revenue Code, and described in s. 501(c) of the Internal Revenue
  581  Code, which delivers health care services provided by licensed
  582  professionals listed in this paragraph, any federally funded
  583  community health center, and any volunteer corporation or
  584  volunteer health care provider that delivers health care
  585  services.
  586         (4) CONTRACT REQUIREMENTS.—A health care provider that
  587  executes a contract with a governmental contractor to deliver
  588  health care services on or after April 17, 1992, as an agent of
  589  the governmental contractor, or any employee or agent of such
  590  health care provider, is an agent for purposes of s. 768.28(9),
  591  while acting within the scope of duties under the contract, if
  592  the contract complies with the requirements of this section and
  593  regardless of whether the individual treated is later found to
  594  be ineligible. A health care provider, or any employee or agent
  595  of such health care provider, shall continue to be an agent for
  596  purposes of s. 768.28(9) for 30 days after a determination of
  597  ineligibility to allow for treatment until the individual
  598  transitions to treatment by another health care provider. A
  599  health care provider, or any employee or agent of such health
  600  care provider, under contract with the state may not be named as
  601  a defendant in any action arising out of medical care or
  602  treatment provided on or after April 17, 1992, under contracts
  603  entered into under this section. The contract must provide that:
  604         (a) The right of dismissal or termination of any health
  605  care provider delivering services under the contract is retained
  606  by the governmental contractor.
  607         (b) The governmental contractor has access to the patient
  608  records of any health care provider delivering services under
  609  the contract.
  610         (c) Adverse incidents and information on treatment outcomes
  611  must be reported by any health care provider to the governmental
  612  contractor if the incidents and information pertain to a patient
  613  treated under the contract. The health care provider shall
  614  submit the reports required by s. 395.0197. If an incident
  615  involves a professional licensed by the Department of Health or
  616  a facility licensed by the Agency for Health Care
  617  Administration, the governmental contractor shall submit such
  618  incident reports to the appropriate department or agency, which
  619  shall review each incident and determine whether it involves
  620  conduct by the licensee that is subject to disciplinary action.
  621  All patient medical records and any identifying information
  622  contained in adverse incident reports and treatment outcomes
  623  which are obtained by governmental entities under this paragraph
  624  are confidential and exempt from the provisions of s. 119.07(1)
  625  and s. 24(a), Art. I of the State Constitution.
  626         (d) Patient selection and initial referral must be made by
  627  the governmental contractor or the provider. Patients may not be
  628  transferred to the provider based on a violation of the
  629  antidumping provisions of the Omnibus Budget Reconciliation Act
  630  of 1989, the Omnibus Budget Reconciliation Act of 1990, or
  631  chapter 395.
  632         (e) If emergency care is required, the patient need not be
  633  referred before receiving treatment, but must be referred within
  634  48 hours after treatment is commenced or within 48 hours after
  635  the patient has the mental capacity to consent to treatment,
  636  whichever occurs later.
  637         (f) The provider is subject to supervision and regular
  638  inspection by the governmental contractor.
  639         (g) As an agent of the governmental contractor for purposes
  640  of s. 768.28(9), while acting within the scope of duties under
  641  the contract, A health care provider licensed under chapter 466,
  642  as an agent of the governmental contractor for purposes of s.
  643  768.28(9), may allow a patient, or a parent or guardian of the
  644  patient, to voluntarily contribute a monetary amount to cover
  645  costs of dental laboratory work related to the services provided
  646  to the patient within the scope of duties under the contract.
  647  This contribution may not exceed the actual cost of the dental
  648  laboratory charges.
  649  
  650  A governmental contractor that is also a health care provider is
  651  not required to enter into a contract under this section with
  652  respect to the health care services delivered by its employees.
  653         (5) NOTICE OF AGENCY RELATIONSHIP.—The governmental
  654  contractor must provide written notice to each patient, or the
  655  patient’s legal representative, receipt of which must be
  656  acknowledged in writing at the initial visit, that the provider
  657  is an agent of the governmental contractor and that the
  658  exclusive remedy for injury or damage suffered as the result of
  659  any act or omission of the provider or of any employee or agent
  660  thereof acting within the scope of duties pursuant to the
  661  contract is by commencement of an action pursuant to the
  662  provisions of s. 768.28. Thereafter, or with respect to any
  663  federally funded community health center, the notice
  664  requirements may be met by posting in a place conspicuous to all
  665  persons a notice that the health care provider, or federally
  666  funded community health center, is an agent of the governmental
  667  contractor and that the exclusive remedy for injury or damage
  668  suffered as the result of any act or omission of the provider or
  669  of any employee or agent thereof acting within the scope of
  670  duties pursuant to the contract is by commencement of an action
  671  pursuant to the provisions of s. 768.28.
  672         Section 11. Paragraphs (a) and (b) of subsection (9) of
  673  section 768.28, Florida Statutes, are amended to read:
  674         768.28 Waiver of sovereign immunity in tort actions;
  675  recovery limits; limitation on attorney fees; statute of
  676  limitations; exclusions; indemnification; risk management
  677  programs.—
  678         (9)(a) An No officer, employee, or agent of the state or of
  679  any of its subdivisions may not shall be held personally liable
  680  in tort or named as a party defendant in any action for any
  681  injury or damage suffered as a result of any act, event, or
  682  omission of action in the scope of her or his employment or
  683  function, unless such officer, employee, or agent acted in bad
  684  faith or with malicious purpose or in a manner exhibiting wanton
  685  and willful disregard of human rights, safety, or property.
  686  However, such officer, employee, or agent shall be considered an
  687  adverse witness in a tort action for any injury or damage
  688  suffered as a result of any act, event, or omission of action in
  689  the scope of her or his employment or function. The exclusive
  690  remedy for injury or damage suffered as a result of an act,
  691  event, or omission of an officer, employee, or agent of the
  692  state or any of its subdivisions or constitutional officers is
  693  shall be by action against the governmental entity, or the head
  694  of such entity in her or his official capacity, or the
  695  constitutional officer of which the officer, employee, or agent
  696  is an employee, unless such act or omission was committed in bad
  697  faith or with malicious purpose or in a manner exhibiting wanton
  698  and willful disregard of human rights, safety, or property. The
  699  state or its subdivisions are shall not be liable in tort for
  700  the acts or omissions of an officer, employee, or agent
  701  committed while acting outside the course and scope of her or
  702  his employment or committed in bad faith or with malicious
  703  purpose or in a manner exhibiting wanton and willful disregard
  704  of human rights, safety, or property.
  705         (b) As used in this subsection, the term:
  706         1. “Employee” includes any volunteer firefighter.
  707         2. “Officer, employee, or agent” includes, but is not
  708  limited to, any health care provider, and its employees or
  709  agents, when providing services pursuant to s. 766.1115; any
  710  nonprofit independent college or university located and
  711  chartered in this state which owns or operates an accredited
  712  medical school, and its employees or agents, when providing
  713  patient services pursuant to paragraph (10)(f); and any public
  714  defender or her or his employee or agent, including, among
  715  others, an assistant public defender or and an investigator.
  716         Section 12. Except as otherwise expressly provided in this
  717  act, this act shall take effect July 1, 2016.
  718  
  719  ================= T I T L E  A M E N D M E N T ================
  720  And the title is amended as follows:
  721         Delete everything before the enacting clause
  722  and insert:
  723                        A bill to be entitled                      
  724         An act relating to health care; creating s. 381.4019,
  725         F.S.; establishing a joint local and state dental care
  726         access account initiative, subject to the availability
  727         of funding; authorizing the creation of dental care
  728         access accounts; specifying the purpose of the
  729         initiative; defining terms; providing criteria for the
  730         selection of dentists for participation in the
  731         initiative; providing for the establishment of
  732         accounts; requiring the Department of Health to
  733         implement an electronic benefit transfer system;
  734         providing for the use of funds deposited in the
  735         accounts; requiring the department to distribute state
  736         funds to accounts, subject to legislative
  737         appropriations; authorizing the department to accept
  738         contributions from a local source for deposit in a
  739         designated account; limiting the number of years that
  740         an account may remain open; providing for the
  741         immediate closing of accounts under certain
  742         circumstances; authorizing the department to transfer
  743         state funds remaining in a closed account at a
  744         specified time and to return unspent funds from local
  745         sources; requiring a dentist to repay funds in certain
  746         circumstances; authorizing the department to pursue
  747         disciplinary enforcement actions and to use other
  748         legal means to recover funds; requiring the department
  749         to establish by rule application procedures and a
  750         process to verify the use of funds withdrawn from a
  751         dental care access account; requiring the department
  752         to give priority to applications from dentists
  753         practicing in certain areas; requiring the Department
  754         of Economic Opportunity to rank dental health
  755         professional shortage areas and medically underserved
  756         areas; requiring the Department of Health to develop a
  757         marketing plan in cooperation with certain dental
  758         colleges and the Florida Dental Association; requiring
  759         the Department of Health to annually submit a report
  760         with certain information to the Governor and the
  761         Legislature; providing rulemaking authority to require
  762         the submission of information for such reporting;
  763         amending s. 395.002, F.S.; revising the definition of
  764         the term “ambulatory surgical center” or “mobile
  765         surgical facility”; amending s. 395.003, F.S.;
  766         requiring, as a condition of licensure and license
  767         renewal, that ambulatory surgical centers provide
  768         services to specified patients in at least a specified
  769         amount; requiring ambulatory surgical centers to
  770         report certain data; defining a term; requiring
  771         ambulatory surgical centers to comply with certain
  772         building and lifesafety codes in certain
  773         circumstances; creating s. 624.27, F.S.; defining
  774         terms; specifying that a direct primary care agreement
  775         does not constitute insurance and is not subject to
  776         ch. 636, F.S., relating to prepaid limited health
  777         service organizations and discount medical plan
  778         organizations, or any other chapter of the Florida
  779         Insurance Code; specifying that entering into a direct
  780         primary care agreement does not constitute the
  781         business of insurance and is not subject to ch. 636,
  782         F.S., or any other chapter of the code; providing that
  783         certain certificates of authority and licenses are not
  784         required to market, sell, or offer to sell a direct
  785         primary care agreement; specifying requirements for a
  786         direct primary care agreement; providing a short
  787         title; amending s. 409.967, F.S.; requiring a managed
  788         care plan to establish a process by which a
  789         prescribing physician may request an override of
  790         certain restrictions in certain circumstances;
  791         providing the circumstances under which an override
  792         must be granted; defining the term “fail-first
  793         protocol”; creating s. 627.42392, F.S.; requiring an
  794         insurer to establish a process by which a prescribing
  795         physician may request an override of certain
  796         restrictions in certain circumstances; providing the
  797         circumstances under which an override must be granted;
  798         defining the term “fail-first protocol”; amending s.
  799         641.31, F.S.; prohibiting a health maintenance
  800         organization from requiring that a health care
  801         provider use a clinical decision support system or a
  802         laboratory benefits management program in certain
  803         circumstances; defining terms; providing for
  804         construction; creating s. 641.394, F.S.; requiring a
  805         health maintenance organization to establish a process
  806         by which a prescribing physician may request an
  807         override of certain restrictions in certain
  808         circumstances; providing the circumstances under which
  809         an override must be granted; defining the term “fail
  810         first protocol”; amending s. 766.1115, F.S.; revising
  811         the definitions of the terms “contract” and “health
  812         care provider”; deleting an obsolete date; extending
  813         sovereign immunity to employees or agents of a health
  814         care provider that executes a contract with a
  815         governmental contractor; clarifying that a receipt of
  816         specified notice must be acknowledged by a patient or
  817         the patient’s representative at the initial visit;
  818         requiring the posting of notice that a specified
  819         health care provider is an agent of a governmental
  820         contractor; amending s. 768.28, F.S.; revising the
  821         definition of the term “officer, employee, or agent”
  822         to include employees or agents of a health care
  823         provider as it applies to immunity from personal
  824         liability in certain actions; providing effective
  825         dates.